Ebola Journal Entries

Canadian World Medical Mission nurses and doctors shares their experience treating Ebola patients in Liberia, Africa.

For more information about how Samaritan's Purse is responding to the latest outbreak of Ebola, click here.

July 26, 2014: Pray for Williamby Dorothy McEachern, RN

We are praying for a young 12-year-old boy in our unit, His name is William. He lost his mother to Ebola and now he has been with us for over two weeks. He was one of Dr. Azaria Marthyman's first patients and the doctor was very aggressive at rehydrating him when he first came in. He was very ill and Dr. Azaria was so pleased to hear that William is still alive. We are hoping that he will be without symptoms for 72 hours so we can do a blood test to confirm if he is negative for Ebola. He must have no fever or diarrhea before we do the test. He now has a great appetite, and we bring him extra food from our house as well as the hospital food that he gets.

We read him children’s Bible stories from outside the unit as he sits on the inside. Wendy, one of our volunteer hygienists, reads to him every day and tells him about Jesus. I love listening to her too!

July 25, 2014: On the Moveby Dorothy McEachern, RN

We’ve just moved in to a larger case management center at Elwa. It’s across the road from where we were before and can hold about 20 patients compared to five at the previous location. Samaritan’s Purse is already building another structure, which will contain 60 beds, in anticipation of a large influx of new patients. We pray it won't be needed.

I worked in Haiti in 2011 after the cholera outbreak. There are similarities in the living conditions but with cholera, there was not as much death. Cholera can be treated with good outcome. If patients come to the hospital in time, they can be rehydrated and get better. With Ebola, if they come in as soon as any symptoms occur, they have a better chance of recovery. But mostly, we celebrate the fact that we have a shift with no deaths. I have only had two shifts so far where there has not been at least one body to remove.

July 24, 2014: Homeward Boundby Dr. Azaria Marthyman

I had a wonderful flight in the cockpit of the plane from Foya to Monrovia this morning. The ride was smooth and the bird’s-eye view over the mountains, rivers, and valleys was spectacular, lush, and green.

I am doing very well physically and emotionally, having worked every day since my arrival in Liberia, and today having to say goodbye to so many people. Working closely with other members of the team brings out the good, the bad, and the ugly, but in the end, we have each grown in our character. Special bonds and memories have developed that can only be fully appreciated among us.

After a short time at the Samaritan’s Purse Liberia office headquarters, I went over to the expanded ELWA Case Management Center. A young boy was sitting on a chair quietly observing the activities around him. I recognized his features and asked if his name is William. William was my first Ebola patient here and now I have the privilege of interacting with him again before I leave Liberia. William now needs a home to go to. He does not have any family to care for him and will be under the ministry’s care. I pray that he will have a loving home to go to. Meeting William today seems to bring some closure to my stay here in Liberia as I prepare myself to come home to my wife and family.

July 23, 2014: Protection is Keyby Dorothy McEachern, RN

We treat our patients by rehydrating them intravenously if they are too weak and unable to drink because of the excess diarrhea or vomiting. We start them on antibiotics and possibly anti-malarial drugs because the initial symptoms of malaria are similar to Ebola. We give them pain medication if necessary and try to keep them as comfortable as possible.

To protect ourselves we must be completely covered from head to toe. We are all checked prior to entering the unit to confirm that there is no skin exposed. Before entering, we then pray as a team. We try not to stay in the unit more than two hours. The heat can be a real problem. I became short of breath after lifting a patient but it is too dangerous to remove your mask without being properly decontaminated. The feeling is overwhelming when you can't seem to breathe. God had always helped to calm us and let us carry on with what is needed.

Decontamination takes about 15 minutes. We are soaked in sweat from head to toe. One time I feared that I had a breach as there was a large amount of water in one of my gloves but it was just accumulated sweat.

July 23, 2014: No, Never alone!by Dr. Azaria Marthyman

We always go into the isolation units with a partner—never alone! This has been strictly followed by all of us who are on the front lines wearing our personal protective equipment (PPE) as we interact directly with those infected by the Ebola virus. This ensures that there is help in the event that a person in PPE gets into trouble physically. It is easy to overheat or to have a PPE compromised in some way while doing our duties. We often examine each other in the midst of our activities.

In our work here at the Foya Case Management Center, we have learned to trust and depend on each other. Every person working here needs to do his or her part to ensure integrity in avoiding contamination. The doctors and nurses are conscientiously doing our part to never leave sharp needles around and to clean blood or body fluids from our patients with chlorinated water. Likewise, we also need to trust that the hygienists do their part in cleaning and decontaminating the reusable items such as goggles, plastic aprons, rubber boots, etc. that we wear as part of our PPE, as well as cleaning and decontaminating the facilities.

This place is hustling and bustling with activities and to the outsider it can appear chaotic. But there is an organized system. We have expanded and our capacity can now accommodate about 40 patients. Our latest statistics show our case fatality rate to be around 40 percent. I am thankful for the continued steady improvements in the way we operate the Case Management Center. We want to care for our patients as best as possible. Fallah and Nyuma are brothers who have benefited from our medical care.

Eight-year-old Fallah was discharged yesterday but his seven-year-old brother Nyuma is still admitted. Six days ago, Nyuma and Fallah were near death. I was busy for several days, suiting up in PPE numerous times each day to monitor their progress and to maintain their cardiovascular status with IV fluid. Each day and night, we were worried they would not survive. They were not able to eat or drink, and were having profuse diarrhea. One morning, I found Nyuma barely having a pulse. Both were unresponsive. I supervised their IV fluid resuscitation and prayed, and prayed. We all prayed!

Fallah and Nyuma gradually recovered. Now, Fallah’s test showed that he is cured from the Ebola virus and was able to come out of the isolation unit while Nyuma’s test still showed some viral activity. Nyuma cried when his brother was discharged but understood that his turn will soon come to be discharged once his test result also becomes clear.

Nyuma is able to eat, drink, and walk. He was in the isolation courtyard getting fresh air when I came over at the other side of the fence and yelled at him, “Hey Nyuma!” He turned towards me, recognizing my voice and smiled while coming closer towards me. He reached out with his hand, wanting me to reach back the way I have done while in my PPE in his room, but this time I was not able to cross the barrier to touch him. I tried to explain and he seemed to understand that I was not allowed to touch him but hopefully in a few days I could give him a hug.

Fallah is now quite well, still recovering and getting stronger in the convalescence unit. He smiles at me every time I come to him, and he holds onto me. He and I can now embrace, with no barrier!

What a special privilege and honor to have been caring for Nyuma and Fallah! I was able to tell them that they are never alone. God is with them!

July 22, 2014: Team Work!by Dr. Azaria Marthyman

What a privilege to be working with such an awesome international team. The Foya Case Management Centre has gained credibility in this region.

I have been amazed at the caliber of Samaritan’s Purse staff here in Liberia. Without the dedication, ingenuity, and flexibility of the members of our team, we would not be accomplishing all that we have been doing. Personnel in Logistics, WASH (Water and Sanitation Hygiene), IT (Information Technology), Communications, Administration, etc., are all critical components that support the medical work we do in battling the Ebola outbreak here in this region. Thank-you to all who work in support of the medical care we are providing for our Ebola infected patients.

Since a week ago, we have had numerous patients coming to our Foya Case Management Centre from across the borders of Sierra Leone, and Guinea. We have also had people coming from other parts of Liberia. Out of curiosity, we have been asking them why they travel the distance to come to our Case Management Centre here in Foya. “We have heard that people get better here!” they tell us. Wow! The Foya Case Management Centre has gained such positive reputation that people are coming for treatment here. Praise be to God! May His grace continue to abound as we humbly care for our patients. May the love of Jesus Christ be known to all who come here.

July 20, 2014: Meet Tawa, an Ebola Survivor!by Dr. Azaria Marthyman

Meet Tawa Tamba, an Ebola survivor who just got discharged! She gives glory to God — and has given me permission to share her story.

Tawa was married with three children and lives in a community near the Foya Case Management Centre. Four weeks ago, her husband became very sick and died. Tawa came to our Case Management Centre when one of her children became sick with similar symptoms that her husband manifested. She realized she needed to get help for possible Ebola infection. She witnessed two of her children die, and she herself became very sick. Her six-year-old son Saah amazingly remained symptom free and his tests remained negative throughout. He was cared for by our Centre in the convalescence unit during Tawa’s admission since no extended family member and no one in her community agreed to take Saah for fear that he would transmit the virus. Today, we said, “Goodbye!” to Tawa and Saah. Saah cried and did not want to leave because he had become attached to us. What a sweetie!

Tawa expressed her gratitude to God foremost and to all those who helped. “I never lost hope because I know God is in control! Thank you for praying for me every time you treated me!”

With a smile, Tawa expressed, ”Thank you, I’m going home!”

July 19, 2014: Awareness and Preventionby Dr. Azaria Marthyman

Community acceptance and awareness is on the rise!

I was supposed to have the day off today, but instead, I was pulled in to take part in a four-member teaching team for educating and orientating a delegation of hospital staff from another district. The delegation comprised of a lead medical doctor, nurses, a laboratory technician, and hospital administrators. It was a privilege for me to have shared our experiences here at the Foya Case Management Center with other health care professionals and administrators. This particular major hospital where the delegation came from is in an area where the community has resisted the awareness campaigns that have been launched by the various partnering organizations battling the current Ebola outbreak. Staff from Medecins Sans Frontieres have been working to establish a staging satellite that will capture Ebola patients and quickly refer these patients to our Case Management Center.

Community awareness is critical so that Ebola patients can be identified quickly, isolated for early intervention and treatment, and preventative measures can be implemented to prevent transmission and spread of the virus. The multi-faceted collaborative social awareness campaign is working over time. Along with collaborating partners, the Liberian Ministry of Health even commissioned a song on Ebola, which is now aired frequently in Liberia.

When I first began my clinical work here in Liberia, I received my orientation at the ELWA Case Management Center in Monrovia. On July 5, I shared about the 12-year-old boy that Dr. Eisenhut and I admitted. He was my first Ebola patient. At the time, we had to carry him from the ambulance into the isolation unit, and we were afraid that he was not going to survive the night. We started an IV line to provide fluid replenishment for his body and began the medications that are part of the management protocol for his comfort, as well as medications that reduce the risk of septic shock, malaria, etc. Remarkably, he has survived and is now getting stronger.

Thank-you to all who prayed for this boy!

July 17, 2014: Will I be like the Samaritan?by Dr. Azaria Marthyman

“Are you crazy?” is what I know goes through the minds of some when they find out I am treating Ebola-infected patients. Media reporters ask me about the danger I place myself into by being here: “How do you feel putting yourself at risk?”

The reality is that I am at a risk that is known, and as such, all precautions are taken to protect myself. The Ebola virus is not airborne in transmission unless an infected person directly coughs onto another’s face. It is transmitted through close contact with bodily fluids such as vomit, urine, blood, or saliva. The virus is killed simply with low concentration chlorinated water. In fact, 0.5 percent chlorinated water solution is used to wash and spray contaminated items and hard surfaces, and 0.05 percent chlorinated water solution is used to wash gloved hands and skin surfaces.

Over the years, there has not been a single case of an expat caregiver contracting Ebola while working in the field treating Ebola-infected patients. For doctors and nurses who are presently contemplating and struggling with the decision of whether or not to volunteer professional services with Samaritan’s Purse, I can report that I feel well-equipped, well-supported, well-trained, and well-protected here in the Foya Case Management Center.

Why am I here in Liberia treating Ebola-infected patients? As a Christian doctor, I have chosen to respond to the call of being a tangible extension of the love of Christ. The fact that I am with an organization called Samaritan’s Purse is very fitting. The well-known Bible story of a person who was hurt, helpless, and needing to be rescued is easily accepted intellectually. And credit is given to the Samaritan who chose to get dirty and help. When the plea for help came for me to render my medical skills in the current Ebola outbreak in West Africa, I was challenged to examine my own convictions. Will I be like the Samaritan, or will I pass on by, remaining in my comforts? Do not withhold good from those to whom it is due, when it is in your power to act.” (Proverbs 3:27, NIV).

July 16, 2014: Caring for Othersby Dr. Azaria Marthyman

As I am sitting here writing, the tropical rain falls in torrents, and the thunders roar explosively. One cannot help but be startled each time the thunder explodes. News of a positive Ebola blood test must be startling to the patient being told; I can only imagine what it must be like to hear, “Unfortunately, your test for Ebola is positive.”

Today, I had to tell an Ebola-suspected grandmother, S.K., that her 15-month-old granddaughter, K.K., has tested positive but that her own test is negative thus far. This type of situation creates a real dilemma: who is going to care for the child who has Ebola when the family members are not positive? A child this young will need companionship, supervision, and round-the-clock care. Yesterday, the mother of a two-year-old boy died of Ebola. S.K. agreed to care for this young lad, but now she has to let go of the care of her own granddaughter, K.K., to another woman. After spending time with her, she realized the importance of protecting herself from the disease, and to have her granddaughter, K.K., be treated in the confirmed ward. S.K is a courageous woman!

Ebola is a nasty disease that isolates the victim from family and friends. It is a lonely way to die. I am so thankful for the compassion, love, and care that our health caregivers provide for these patients. We aim at providing dignity in the midst of such devastating circumstances where the Ebola-infected person loses control of bodily functions, becoming totally dependent, and at the mercy of the nurses, hygienists, and doctors. I am limited to using my words, my tone of voice, the touch of my hands, and my eyes’ expressions as I interact with our patients. I can only pray that these patients sense and know that I care! I truly do care! I am humbled by such limitations. I wish I could do more.

July 14, 2014: Challengesby Dr. Azaria Marthyman

Suffering from dehydration is an unpleasant experience! I am just coming out of it.

Today has been a day of administrative work for me, rather than clinical, while I recover. With input from the rest of the team, I managed to develop and complete a standardized “Doctor’s Admission and Management Form,” which hopefully will help us in our clinical charting and medical progress-keeping for each of our patients.

There has been an influx of patients coming into the Case Management Center, and all hands are on deck. At the end of the day yesterday, I was quite exhausted. I slept well, but when I woke up this morning, I felt awful. When I first got out of bed, my head started to spin. I managed to slowly allow my body to adjust to the postural change. My heart was beating faster than usual, my eyes slow to focus, and my thoughts were sluggish. Despite the liters of hydration fluids I have been drinking throughout each day, my body became dehydrated.

Being in the personal protective equipment with every patient I encounter brings about challenges to a caregiver’s health, along with challenges in clinical management. I have had to rely heavily on my hands, fingers, and visual observations to tell me the status of patients. I do not have the luxury of a stethoscope or blood pressure cuff, as these devices are rendered useless with the protective clothing that I am required to wear. Therefore clinical astuteness is key without the items and tools that I have been accustomed to in Canada.

I am finally feeling better again this evening. I hope that after another good night’s sleep, I will be ready to tackle tomorrow’s challenges.

July 12, 2014: Pointing People to the Light of Jesus Christby Dr. Azaria Marthyman

I was awakened at 2:15 in the morning. The nurse on the phone informed me that a very sick woman had arrived by ambulance. As I walked down the narrow dirt path to the Foya Case Management Center, the thought of possibly encountering a snake came to mind, subconsciously causing me to quicken my steps. It was still and pitch-black, the only light coming from my flashlight. As I stumbled along the path, I was struck by the thought that I cannot know my future, and each person must grapple with mortality. Yet my hope is in the Lord, and in Him will I put my trust.

When I arrived at the nursing station, we discussed how we would assess the patient in the ambulance, and decided that we would be in full personal protective equipment (PPE). The woman in the ambulance was very ill—unable to walk and barely coherent. She was bleeding from her mouth and was declining rapidly. Her adult son came with her in the ambulance and as I advised him of the precarious condition his mother was in, he asked, “What can be done?” I told him that we would do all we could for his mother medically, and that I would talk with him further after I came out of the PPE. Being the unknown doctor with only my eyes showing through the intimidating PPE makes it difficult to offer counseling to concerned family members.

“Your mother is very sick,” I told him. “Please pray for her!” I felt helpless as a doctor, knowing that she was unlikely to survive. She died later that day. Her son asked me, “What do I need to do for myself?” I told him he’s at risk of having contracted the Ebola virus from his mother, and that he needs to monitor himself for the virus’s symptoms. Although the world looks dark and grim to him, I tried to point him towards the light of the world, Jesus Christ.

Being in the midst of death makes me reflect on how fragile life is. Ebola is the invisible enemy that infects a person, causes significant sickness, and potentially kills the person. Some survive the battle, but many lose their lives.

Psalm 27 says, “Hear my voice when I call, Lord; be merciful to me and answer me. My heart says of you, ‘Seek his face!’ Your face, Lord, I will seek…I remain confident of this: I will see the goodness of the Lord in the land of the living. Wait for the Lord; be strong and take heart and wait for the Lord.”

July 11, 2014: Certificates of Healingby Dr. Azaria Marthyman

Hello from Foya, Liberia,

As a point of interest, I designed a certificate just yesterday that we now give to patients who have been treated and cured from Ebola. It states that the patient named on the certificate was treated, is cured, and no longer contagious. Some of these patients cannot go back easily to their communities because of fear by the community that the cured patient can still infect others. So the certificate is official, a true document, signed by the Foya Case Management Centre doctor and co-signed by the Ministry of Health and Social Welfare. It also states the township and district the person usually resides to allow movement/travel, as we get patients from Guinea and Sierra Leone as well as other districts, and so crossing the border, etc can be an issue when they do not have any identification.

July 10, 2014: The Power of Prayerby Dr. Azaria Marthyman

Joyous day of celebration! After briefly grieving the death of the little boy that turned for the worse yesterday, my focus turned onto three patients that are now cured and were discharged today. We are so happy for each of these courageous individuals who braved the Ebola “Valley of Death”, each one now fully acknowledging God’s grace upon their lives. One woman in particular stands out among other Ebola patients in Liberia because she is the first health caregiver to have survived.

National midwives, nurses, and doctors have died after contracting the Ebola virus while on the line of duty. This young nurse that we discharged today came to the Foya Case Management Centre when she and her nurse assistant friend became sick. They did not initially realize that the patients they were caring for were infected with the Ebola virus but with the increased Ebola awareness in their district, they decided to come to our Case Management Centre when they developed symptoms. They come from an area where the people have been in denial that the Ebola virus exists. Unfortunately, this nurse witnessed her friend die from the Ebola hemorrhagic fever, while she herself came to a near death experience. Karen, a nurse with Samaritan’s Purse, said to her, “At this point we have given you all the medications we can and all I have left is to pray for you!” She responded, “Yes please pray for me.” This Ebola survivor now reports that it was after Karen prayed for her that she started to feel better. She gradually improved and was brought back to life!

I had the wonderful privilege of shaking this nurse’s hand publicly while presenting her the Post Treatment Health Certificate in the midst of her coworkers who came to greet her as she came out of our Case Management Centre. Witnessing the tears of joy and utter relief on her face gripped my heart with deep gratitude as I struggled to maintain composure. The public show of shaking her hand has extreme significance here in this community because presently nobody shakes hands due to the fear of contracting the Ebola virus. When I the doctor takes her hand, I declare, “You are cured! You are no longer contagious! Welcome back into the community!” I can only point to Jesus in response to her gratitude, “Glory to God! God loves you and is gracious to you!”

During my afternoon rounds today, a boy we have been treating has turned for the worse. He is now weak, not eating, and barely responsive. My heart feels sick with the knowledge that he is nearing death despite all that we have been doing clinically. The young ones are more vulnerable to the disease, and succumb to the hemorrhagic fever. After doing what we were able to do for this little boy, I walked over to the man in the next room only to find him not breathing, and completely non-responsive. He was still warm and must have just died. All of us, nurses and doctors, were impacted emotionally. Death is so final!

After decontaminating myself out of the personal protective equipment, I rested for a short time while drinking hydration solution. Then a nurse reported that a man who we discharged recently does not feel safe to go back to his community. He was very ill with the Ebola infection but after being near death for over 12 days, he gradually recovered. Now he is afraid that he will not be accepted back in his community, as there have been numerous misconceptions about the Ebola virus. People are afraid. I told him I would write him a discharge certificate, stating he has survived the Ebola infection and is now no longer contagious apart from sexual contact. I shared with him about Jesus and the elements for salvation. He stated that he knows God saved him. I shared with him my testimony and then asked if he was ready to accept Jesus as his Lord and Savior. He replied, “Yes, I am very ready to accept Jesus!” He prayed and accepted Christ!

Today was a day of the highs and the lows emotionally! I feel quite exhausted and will likely crash in bed as long as the bed bugs don’t bite so much. I sprayed the bed and room this morning to try to get rid of these critters.

July 8, 2014: Joy in the Midst of Sufferingby Dr. Azaria Marthyman

It has been heart-breaking to see entire families being wiped out by Ebola. I have mixed emotions. Yet there is hope! Really sick patients are surviving!

I am now in the Foya District of Lofa County, which is at the northern part of Liberia bordering Guinea and Sierra Leone. The countryside is beautiful, mountainous, and green. In the midst of this beauty, the people are terrified since Ebola has affected so many lives.

As a doctor, I ask myself if what we do clinically makes any difference. With historical numbers as high as 90% fatality for those who contract Ebola, I am encouraged to see that our death rates are significantly lower. We have been seeing our patients who were near death now walking again and going home. What joy in the midst of suffering! Our medical care is making a big difference to save lives, bringing hope to the people. With that hope, we are able to point them to the Giver of Life, Jesus!

Today, Samaritan’s Purse officially accepted full responsibility for the entire operation of the Foya Case Management Center, which was initially started by Medecins Sans Frontieres (MSF). With God’s grace, I feel confident that we will provide excellent clinical management for these Ebola victims.

July 5, 2014: My First Ebola Patientby Dr. Azaria Marthyman

After flying across North America, then across the Atlantic Ocean, I finally arrived in Monrovia, Liberia, yesterday evening. The trip seemed to take forever, with a delayed connecting trans-Atlantic flight due to Hurricane Arthur. Over 20 hours later, I was glad to land in Monrovia after one of the bumpiest commercial airplane rides I have had.

I have been learning the approach to community awareness and education, which is critical in preventing a wider spread of what is already a frightening outbreak in the West African region. More relevant to my role as a doctor with the multinational Disaster Assistance Response Team of Samaritan’s Purse, I have been quickly learning the case management protocol outlined by Medecins Sans Frontieres (MSF) for direct patient care of these poor souls infected by Ebola. I feel indebted to MSF for the tremendous work that has been done and the knowledge shared. There is so much unknown about this enemy we call the Ebola virus, which admittedly brings me to feeling significant apprehensions as I treat the Ebola victims.

This evening, Dr. Eisenhut and I admitted a 12-year-old boy that has classic signs and symptoms of Ebola, whose foster mother died recently from Ebola. This is my first Ebola patient here. He has been sick only five days and with the severity and stage of his illness, Dr. Eisenhut and I fear that he will not make it through the night. Despite our medical efforts, his prognosis is very grim for survival. I pray and hope for a miracle.

Putting on and being in the personal protective equipment (PPE) for the first time was quite an experience. It felt quite restrictive and “closed-in” being in the full body suit, with full head and face protection, double gloved, and eyes shielded by goggles. No area of my skin was exposed! I can only compare the experience to that of being in my flight gear when I flew in the Canadian fighter jets many years ago while serving in the Canadian Military. The breathing feels so much more restrictive and difficult being in my PPE today. After some time, I acclimatized as I focused on the clinical care aspects.

As I am doing frontline clinical management, I need to express my deep appreciation to all those who work to support what I do. The logistical support in getting me here to Liberia, the planning and building of infrastructure, the provision of all the non-medical and medical supplies and equipment, and the care and safety of all members of the team—I am thankful to be part of Samaritan’s Purse and its medical arm, World Medical Mission! I realize that all of what we do cannot be done without the prayers and financial support of all the people from all over the world towards the work of Samaritan’s Purse. Wow! The global Christian community, the family of God, has responded and continues to care! That is awesome!